Health Related Quality of Life in Adults with JIA - a 30 Year Longitudinal Study

Anita Tollisen^1,2,3, Anne Marit Selvaag¹, Hanne A. Aulie¹, Anners Lerdal^4,5 and Berit Flato^1,2, ¹Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, ²Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway, ³Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Oslo, Norway, ⁴Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway, ⁵Lovisenberg Diakonale Hospital, Oslo, Oslo, Norway

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: longitudinal studies, pain, physical impairment and quality of life

Session Information

Date: Tuesday, November 10, 2015

Title: ACR/ARHP Combined Abstract Session: Pediatric Rheumatology

Session Type: ACR/ARHP Combined Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Improvement of health-related
quality of life (HRQOL) is a central aim in treatment
of patients with JIA. The primary aim of the study is
to acquire knowledge about HRQOL in JIA patients, 30 years after disease onset.

Methods: From a total of 336 JIA
patients, first time referred to Oslo University Hospital between 1980-85 and
reassessed after 15 years, 176 participated in a study mean 29.7 (± 2.3) years after disease onset. HRQOL was
assessed by SF-36, physical disability by Health Assessment Questionnaire
Disability Index (HAQ-DI) and pain by Visual Analogue
Scale (VAS pain). Patients, mean age 37.8 (±
4.5), male 27%, were matched to 90 controls selected randomly from the
Norwegian population register.

Results: At 30 year follow-up 102 patients (58%) were
in remission off medication (table 1). Differences in PCS, HAQ-DI
and VAS pain between JIA subtypes were found.

Compared to
controls, patients had reduced HRQOL according to the
SF-36 physical component summary score (PCS) including all subscales of SF-36
except mental health after 30 years (table 2). Between patients with active
disease and patients in remission a difference was found in PCS and HAQ-DI, but both groups had reduced PCS compared to
controls.

From 15 to
30 year follow-up PCS decreased and HAQ-DI increased
(Δ 1.5, p-value 0.046, & Δ 0.08, p-value 0.024, respectively). All disease activity variables
(core set recommended by ACR) assessed at 15-year,
except ESR, correlated with PCS at 30-year follow-up
(table 3). In a multiple linear analysis, HAQ-DI and
VAS pain after 15 years predicted PSC after 30 years.

Conclusion: JIA has a
detrimental effect on HRQOL 30 years after disease
onset; also in patients in clinical remission. HRQOL
worsened from 15 to 30 year follow-up. Physical disability (HAQ-DI)
and pain (VAS) after 15 years predicted physical health assessed by PCS after
30 years. However, substantial unexplained variance in HRQOL
exists in adults with JIA.

Tabl.1 Thirty year follow-up, subtypes, gender, SF-36 (PCS and MCS), HAQ-DI, VAS pain and remission status.

Values are medians and ranges if not indicated otherwise.

Disease subtype

N(%)

Female/Male

(% girls)

PCS

MCP

HAQ-DI

VAS pain

Remission* yes/no

(% yes)

Systemic arthritis

12(7)

8/4 (67)

54.8

(28.5-63.7)

54.2

(24.2-61.4)

0.0

(0.0-0.7)

(1-46)

9/3 (75)

Polyarticular RF neg

26(15)

20/6 (95)

45.9

(27.5-64.4)

51.5

(32.4-62.6)

0.3 #

(0.0-1.6)

5⫪

(1-87)

13/13 (50)

Polyarticular RF pos

6(3)

6/0 (100)

48.8

(32.1-51.7)

56.9

(42.9-61.7)

0.9 ⫪#¤

(0.0-1.6)

(2-56)

1/5 (17)

Oligoarticular persistent

52(30)

41/11 (79)

54.6

(26.6-65.4)

54.3

(22.3-62.1)

0.0

(0.0-1.6)

(1-72)

38/14 (73)

Oligoarticular extended

23(13)

18/5 (78)

49.4

(26.5-65.4)

51.2

(29.6-66.9)

0.0

(0.0-1.3)

(1-76)

11/12 (48)

Enthesitis-related arthritis

27(15)

10/17(37)

49.5#

(22.1-61.8)

54.6

(21.3-62.4)

0.06

(0.0-1.5)

(1-100)

12/15 (44)

Psoriatic articular

21(12)

18/3 ( 86)

49.0

(25.5-60.2)

54.4

(25.8-61.8)

0.4

(0.0-1.4)

(1-84)

12/9 (57)

Undifferentiated arthritis

9(5)

8/1 (89)

47.1

(27.3-62.3)

54.3

(29.5-62.6)

0.0

(0.0-1.6)

(1-47)

6/3 (67)

Total

176

102/74

* 12 months of inactive disease off medication.

⫪ P<0.05 vs systemic arthritis, # P<0.05 vs oligoarticular persistent, ¤ P<0.05 vs enthesitis related arthritis.

Tabl.2 Mean (SD) HRQOL scores after 30 years in JIA patients.

Variabler

Patients

N=176

Controls

N=90

Patients active disease

N= 74

Patients in remission, off medication

N= 102

Physical functioning

Role physical

Bodily pain

General health

SF-36 PCS

Vitality

Social functioning

Role emotional

Mental health

SF-36 MCS

VAS Pain

HAQ-DI

83.4 (19.3)*

69.7 (40.0)*

72.7 (23.6)*

66.7 (25.2)*

48.5 (10.8)*

52.6(25.0)*

83.6(21.9)*

78.6 (35.3)*

80.5 (15.7)

50.5 (10.3)

16.2 (22.8)

0.35 (0.49)

95.3 (9.6)

91.1 (21.6)

83.3 (19.3)

78.2 (17.7)

55.2 (6.4)

61.8 (23.0)

92.4 (14.8)

90.0 (26.2)

83.8 (14.6)

52.6 (8.9)

79.1 (20.2)*#

62.7 (40.9)*

70.6 (21.6)*

61.8 (23.7)*

46.1 (10.2)*#

49.5 (22.7)*

82.6 (21.5)*

79.4 (33.4)*

80.5 (15.6)

51.0 (10.1)

20.4 (20.4)

0.47(0.54)#

86.5 (18.2)*

74.8 (38.8)*

74.2 (24.9)*

70.2 (25.7)*

50.2(11.0)*

54.8 (26.5)

84.4 (22.3)*

78.1 (36.8)*

80.6 (15.9)

50.2(10.4)

14.7(22.8)

0.26 (0.43)

P-values were determined by Independent Sample T-test. * Patients vs controls p-value ² 0.01,

# Patients active disease vs patients in remission p-value ² 0.01.

Tabl.3 Association between PCS at 30-year follow-up and disease variables at 15 years (n= 160).
	Univariat Analysis		Multiple Regression Analysis¹
	Pearsons correlation coefficient	P-value	R²	Standardized B	P-value
Gender	-0.106	0.160
Age	-0.158	0.036
HAQ 15yrs	-0.474	< 0.001*		-2.045	< 0.001
Pain VAS 15 yrs	-0.398	< 0.001*		-0.040	0.050
SR 15 yrs	-0.118	0.129
Patients global assessment of overall well-being	-0.239	< 0.002#
Physicians global assessment of overall disease activity	-0.275	< 0.001*
Number of joints with active arthritis	-0.259	0.001#
Number of joints with limited range of motion	-0.202	0.008*
			0.225
¹ Results from the final model of multiple linear regression analysis (backward regression methods). * Variables entered in the multiple regression model, # Highly intercorrelated variables.

Disclosure: A. Tollisen, None; A. M. Selvaag, None; H. A. Aulie, None; A. Lerdal, None; B. Flato, None.

To cite this abstract in AMA style:

Tollisen A, Selvaag AM, Aulie HA, Lerdal A, Flato B. Health Related Quality of Life in Adults with JIA – a 30 Year Longitudinal Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/health-related-quality-of-life-in-adults-with-jia-a-30-year-longitudinal-study/. Accessed .

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